Basic Information
| Provider Information | |||||||||
| NPI: | 1619090438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | ROSEANNE | ||||||||
| MiddleName: | LAVELLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHIELDS | ||||||||
| OtherFirstName: | ROSEANNE | ||||||||
| OtherMiddleName: | LAVELLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10 CENTENNIAL DR | ||||||||
| Address2: | |||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019607938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785351110 | ||||||||
| FaxNumber: | 9785352907 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 CENTENNIAL DR | ||||||||
| Address2: | |||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019607938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785351110 | ||||||||
| FaxNumber: | 9785352907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2007 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 225602 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.